Application Of Ultrasound-guided Ilihypogastric And Ilioinguinal Nerve Block Anesthesia In Tension-free Inguinal Hernia Repair In Elderly Patients

Objective:To investigate the effect of ultrasound-guided ilihypogastric and ilioinguinal nerve block anesthesia in tension-free hernia repair in advanced age patients,and to explore its safety and feasibility and effectiveness.Methods:This study was a prospective randomized controlled study.Advanced age patients with inguinal hernia,aged≥80 years old,ASA grade I～III,BMI 18～23kg/m²who underwent elective tension-free hernia repair in this hospital from January 2019 to June2021 were recruited.All patients were randomly divided into CSEA group and IINB group.Patients in CSEA group were anesthetized with combined spinal epidural anesthesia,patients in IINB group were anesthetized under ultrasound-guided ilihypogastric and ilioinguinal nerve block.The mean arterial pressure（MAP）,heart rate（HR）and blood oxygen saturation（Sp O₂）before anesthesia（T₁）,20 minutes after anesthesia（T₂）and at the end of operation（T₃）were recorded.Visual analogue scale（VAS）was recorded during the operation and after operation for rest and exercise at 2,12and 24 hours after operation.The operative time,postoperative time out of bed,feeding time,length of hospital stay,hospital cost,postoperative complications and anesthesia satisfaction were compared between the two groups.Results:1.A total of 100 advanced age patients with inguinal hernia were enrolled in the study.One patient in CSEA group withdrew from the study due to changing the operation mode,one patient in IINB group withdrew from the study,because the patient can not cooperate and temporarily requested to change the anesthesia method.All other patients successfully completed the operation according to the anesthesia method and operation plan.There were no significant differences between two groups in gender,age,BMI index,disease type,ASA grade and the proportion of complications（P>0.05）.2.There was no significant difference in MAP,HR and Sp O₂at each time in iinb group（P>0.05）.Compared with T₂,MAP in CSEA group increased significantly compared with T₁and T₃（P<0.05）;HR decreased significantly at T₂（P<0.05）.There were significant differences in MAP and HR at T₂between the two groups（P<0.05）.3.The VAS scores of IINB group at 12 hours after operation were lower than those in CSEA group（P<0.05）.4.There was no significant difference in anesthesia time between IINB group and CSEA group（P>0.05）,and it was lower than CSEA group in out of bed activity time,eating time,discharge time and hospitalization expenses（P<0.05）.5.The satisfaction of anesthesia in IINB group was significantly higher than that in CSEA group（P<0.05）.The total satisfaction was 95.9%in IINB group and 85.7%in CSEA group.6.The incidence of postoperative nausea/vomiting was 6.1%in IINB group and20.4%in CSEA group（P<0.05）;The incidence of postoperative headache was 8.2%in CSEA group and 0.0%in IINB group（P<0.05）;The incidence of urinary retention in IINB group was 24.5%,and the incidence in group CSEA was 4.1%,the difference was statistically significant（P<0.05）.Conclusion:The results of the study showed that patients in the IINB group performed better than those in the combined dural anesthesia group,including intraoperative hemodynamics was more stable,intraoperative and postoperative VAS scores were significantly reduced,postoperative time of getting out of bed,feeding time and discharge time were significantly shortened,hospitalization costs were significantly reduced,anesthesia satisfaction was higher,and postoperative complications were significantly lower than those in the combined group.The results showed that ultrasound-guided nerve block anesthesia is an ideal,effective and safe anesthesia method for tension-free inguinal hernia repair in the elderly.